How we can bring image-guided therapy closer to patients worldwide

Bringing image-guided therapy to rural areas in China

China is one country where large geographical divides in access to care still exist. Medical institutions and highly-qualified healthcare providers in China have historically concentrated in cities, leaving people in rural areas in a disadvantaged position because they have to travel for many hours to reach the nearest healthcare provider [1]. Fortunately, substantial progress is being made to close the gap between urban and rural healthcare services.

Setting up cardiology centers in India’s tier-two and tier-three cities

In India, another vast country where cardiovascular diseases are taking a growing toll, there is a similar expansion in the number of patients outside metropolitan areas that can now be treated with minimally invasive procedures. 

It’s a much-needed development. In the shadow of the rapid growth of India’s tier-one cities, patients in tier-two and tier-three cities have long had limited access to quality healthcare – a troubling fact for a country in which 1.7 million people die of heart disease each year [2]. 

New hope for previously underserved patients is now on the horizon. Following the launch of the government’s flagship health insurance program Ayushman Bharat in 2018, which makes healthcare more affordable for low-income families, major Indian hospitals are expanding their reach to tier-two and tier-three cities. 

As an example, we are partnering with Artemis Hospitals to set up hospital-based cardiology centers in multiple locations across the country. These centers will provide the much-needed access to high-quality care for populations that in the past had to travel long distances for such care. The aim is to offer an integrated solution for both emergency care and elective procedures, with a complete range of diagnostics, cath labs, and post-procedure ICU care that covers the entire patient pathway. 

Moving procedures to out-of-hospital settings in the U.S.

Today, image-guided therapy is typically conducted in a hospital. But as image-guided systems and devices become more advanced, certain procedures become more routine – which means they may not always require patients to come into the hospital. Instead, procedures can be carried out more quickly and less expensively in outpatient settings such as office-based labs (OBLs) or ambulatory surgery centers (ASCs), which offer a comfortable care environment that is more convenient for patients.

Not only does the shift to these outpatient settings make care more accessible to patients – in a country like the U.S., it is an economic necessity. Driven by the aging of the population, the prevalence and costs of cardiovascular disease in the U.S. are expected to increase dramatically in the next 15 years, with total costs reaching $1.1 trillion by 2035 [3]. As the number of patients continues to grow, the current hospital-centric model of care will become financially unsustainable.

Recognizing this reality, the U.S. Centers for Medicare & Medicaid Services (CMS) announced last year that low-risk percutaneous coronary interventions performed in ASCs will be reimbursed starting 2020. The impact could be significant. CMS estimated that moving 5% of coronary interventions from hospital settings to ASCs would reduce Medicare payments by about $20 million this year alone [4].

In the wake of COVID-19, I expect a further shift of interventional procedures to settings outside of the hospital. At the height of the pandemic, OBLs and ASCs helped relieve pressure from hospitals, offering an alternative for patients who would otherwise have suffered from a delay in care. Now that hospitals are still adapting to new, COVID-19-related standards of care, and patient backlogs remain, collaboration across care settings can help ensure that patients receive timely treatment. 

Raising community awareness for minimally invasive treatment

The benefits of ASCs and OBLs don’t end there. Increased presence of interventional specialists in local communities can also help raise awareness for the possibilities of minimally invasive procedures. 

Today, less well-known but debilitating diseases such as peripheral artery disease often go unrecognized, especially in poor rural areas. People don’t realize that having difficulty walking may be indicative of clogged arteries in their legs. The prospect of a long drive to a large and intimidating hospital can deter them as well. Tragically, they may only make the drive when it’s too late and their leg needs to be amputated. It’s an outcome that could have been prevented with early diagnosis and treatment. Having an outpatient lab nearby can make a big difference here – potentially saving people a limb.

This does not mean that hospitals will become any less relevant in the delivery of image-guided therapy. Instead, I believe that both types of interventional settings complement each other. Shifting low-risk routine procedures to outpatient labs, where they can be performed more efficiently, frees up resources in hospitals to handle complex high-risk procedures. 

Ultimately, this means that more patients can be treated effectively and affordably. And that’s what should inspire us all as we continue to make image-guided therapy more widely available around the world. Because whether it’s a stroke patient in rural China, a heart patient in one of India’s smaller cities, or a vascular patient in an underserved community in the U.S.: every patient matters. 

References

[1] https://www.sciencedirect.com/science/article/pii/S2352013214000726

[2] http://www.healthdata.org/india

[3] http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_491543.pdf

[4] https://www.tctmd.com/news/cms-finalizes-rule-allowing-reimbursement-pci-ambulatory-centers